| NPI | 1578777140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN101) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: FL ACN101) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2023-03-07 |